全膝关节置换术后炎症反应的调节：在一项随机对照试验中，iPACK阻滞对中性粒细胞-淋巴细胞和血小板-淋巴细胞比率的影响

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-04-25 DOI:10.1016/j.tacc.2025.101551

Tomasz Reysner , Grzegorz Kowalski , Aleksander Mularski , Monika Grochowicka , Przemysław Daroszewski , Malgorzata Reysner

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引用次数: 0

摘要

中性粒细胞与淋巴细胞比率（NLR）是全身性炎症和手术应激的标志。本随机对照试验（RCT）评估了罗哌卡因阻滞腘动脉与膝关节囊间浸润（iPACK）对脊柱麻醉下全膝关节置换术（TKA）术后NLR和镇痛效果的影响。方法60例TKA患者随机分为假阻断组（对照组，n = 30）和iPACK阻断组（含20ml 0.2%罗哌卡因，n = 30）。术后12小时的主要预后指标为NLR。次要结果包括24和48小时NLR、血小板与淋巴细胞比率（PLR）、阿片类药物消耗、首次抢救镇痛时间和术后多个时间点的数字评定量表（NRS）疼痛评分。结果iPACK组12 h NLR显著低于对照组(16.87±4.41∶23.95±8.03,p <；0.0001)、24小时(2.27±0.83和4.22±0.59,p & lt;0.0001), 48小时(1.80±0.78和2.81±1.16,p = 0.0002)。各时间点PLR均较低(p <；0.0001),阿片类药物的使用是减少(4.6±1.0毫克/公斤和14.2±1.9毫克/公斤,p & lt;0.0001)，首次抢救镇痛时间延长(7.0±1.6∶3.6±0.7 h, p <；0.0001)。NRS评分显著低于24h (p <；0.0001)，在12 h时差异最大(- 1.8±0.2,95% CI -2.1至- 1.4,p <；0.0001)。结论0.2%罗哌卡因的iPACK阻滞可显著减少TKA术后炎症，改善疼痛控制，减少阿片类药物的消耗。这些发现支持将其纳入多模式镇痛方案，以促进恢复和减少全身炎症。注册：ClinicalTrials.gov （NCT06304298）

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Modulation of postoperative inflammatory response in total knee arthroplasty: Impact of iPACK block on neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in a randomized controlled trial

Background

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and surgical stress. This randomized controlled trial (RCT) evaluated the effect of the infiltration between the popliteal artery and the capsule of the knee (iPACK) block with ropivacaine on postoperative NLR and analgesic outcomes in total knee arthroplasty (TKA) under spinal anesthesia.

Methods

Sixty TKA patients were randomized to receive either a sham block (control, n = 30) or an iPACK block with 20 mL of 0.2 % ropivacaine (n = 30). The primary outcome was NLR at 12 h postoperatively. Secondary outcomes included NLR at 24 and 48 h, platelet-to-lymphocyte ratio (PLR), opioid consumption, time to first rescue analgesia, and numeric rating scale (NRS) pain scores at multiple postoperative time points.

Results

The iPACK group had significantly lower NLR at 12 h (16.87 ± 4.41 vs. 23.95 ± 8.03, p < 0.0001), 24 h (2.27 ± 0.83 vs. 4.22 ± 0.59, p < 0.0001), and 48 h (1.80 ± 0.78 vs. 2.81 ± 1.16, p = 0.0002). PLR was lower at all time points (p < 0.0001), opioid use was reduced (4.6 ± 1.0 mg/kg vs. 14.2 ± 1.9 mg/kg, p < 0.0001), and time to first rescue analgesia was prolonged (7.0 ± 1.6 vs. 3.6 ± 0.7 h, p < 0.0001). NRS scores were significantly lower up to 24 h (p < 0.0001), with the greatest difference at 12 h (−1.8 ± 0.2, 95 % CI -2.1 to −1.4, p < 0.0001).

Conclusions

The iPACK block with 0.2 % ropivacaine significantly reduces postoperative inflammation, improves pain control, and decreases opioid consumption in TKA. These findings support its inclusion in multimodal analgesia protocols to enhance recovery and reduce systemic inflammation.